SBIRT - Coding for SBI Reimbursement

Most doctors and nurses don't know this, but reimbursement for screening and brief intervention is available through commercial insurance CPT codes, Medicare G codes, and Medicaid HCPCS codes.

The Substance Abuse & Mental Health Services Administration or SAMHSA is working with the Centers for Medicare and Medicaid Services (CMS) to educate practitioners about the importance of SBIRT coverage and the Medicare billing rules around these services.

SBIRT services are defined as alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST) and brief intervention.

Commercial Insurance billing codes are CPT 99408 and CPT 99409.
Medicare codes are G0396 and G0397
Medicaid codes are H0049 and H0050

You can learn more about SBIRT coverage here and you can also purchase a novel nursing continuing education activity titled the "SBIRT Substance Use NursingMentor" here: cmecorner.com/sbirt

CPT Billing Codes reimburse for Care Coordination (Medicare)

Let's face it: physicians spend a lot of time coordinating care for their older adult patients, especially when patients leave hospitals or nursing homes. These "transitions of care" are becoming increasingly important opportunities for primary care providers to check medication reconciliation, prevent readmission, and facilitate appropriate follow-up.

Medicare is now accepting newly created Current Procedural Terminology (CPT) codes for care coordination to pay physicians for the management of patients who have recently been discharged from a hospital or skilled nursing facility.

The American Medical Association CPT Editorial Panel created new codes (99495 and 99496) to capture transitional care management services.

Learn more about these CPT codes here.

CMS announces 106 new ACOs

The Centers for Medicare & Medicaid Services (CMS) just announced 106 new Accountable Care Organizations (ACOs) in this press release today.  Since passage of the Affordable Care Act, more than 250 Accountable Care Organizations have been established. Do you know if your state has an ACO?

CMS Innovation Center Update: Comprehensive Primary Care Initiative

The following is an update from the CMS Innovation Center:

The CMS Innovation Center has selected seven geographic markets to carry out the Comprehensive Primary Care initiative, a new multi-payer approach that aims to strengthen the primary care system while achieving better health care and lower costs through improvement. These markets were selected based on a pool of applicants, which include private health plans, state Medicaid agencies, and employers, that proposed to pay for and support comprehensive primary care coordination in partnership with Medicare.

The markets represent a diverse range of regions spanning both coasts, the midwest and south, and rural and urban communities. The selected markets are:

• Arkansas: Statewide
• Colorado: Statewide
• New Jersey: Statewide
• New York: Capital District-Hudson Valley Region
• Ohio: Cincinnati-Dayton Region
• Oklahoma: Greater Tulsa Region
• Oregon: Statewide

Once the participating payers in each market have agreed to the terms and conditions to participate in the initiative by entering into a Memorandum of Understanding with CMS, the Innovation Center will release the application for primary care practices to participate in each market. Approximately 75 primary care practices will be selected to participate in the initiative in each designated market.

Community-based Care Transitions Program (CCTP)

Last week, the Center for Medicare & Medicaid Services (CMS) announced 23 additional participants for the Community-based Care Transitions Program (CCTP). These participants will join seven other community-based organizations already working with local hospitals and other health care and social service providers to support high-risk Medicare patients in maintaining the healing process as they transition from hospital stays to home, a nursing home, or other care setting.

The CCTP is an initiative of the Partnership for Patients, a nationwide public-private partnership that aims to cut preventable errors in hospitals by 40 percent and reduce preventable hospital readmissions by 20 percent over a three-year period. CCTP’s goals are to reduce hospital readmissions, test sustainable funding streams for care transition services, maintain or improve quality of care and document measureable savings to the Medicare program.

The Community-based Care Transitions Program will be hosting a webinar on Tuesday, March 27th, from 3:00pm-4:30pm EDT, to allow stakeholders to hear directly from some of the newly selected sites. CMS Innovation Center staff will provide additional information about the program and will be available to answer questions.

WHAT: Community-based Care Transitions Program Webinar
WHEN: Tuesday, March 27th 3:00pm-4:30pm EDT
WHERE: http://www.visualwebcaster.com/event.asp?id=85800

Participants are strongly encouraged to use the web link for full access to the presentation. If you are unable to hear audio via your computer speakers or would prefer to listen via the telephone, please dial 877-249-8016 and enter code 31613148#.

More information on the CCTP is available at: http://innovation.cms.gov/initiatives/Partnership-for-Patients/CCTP/index.html.

CMS Health Care Innovation Challenge Award Date Approaching

The CMS Health Care Innovation Challenge will be awarding $1 million to $30 million for a three-year period to organizations that propose innovative health care solutions aimed to:

1. Engage a broad set of innovation partners to identify and test new care delivery and payment models that originate in the field and that produce better care, better health, and reduced cost through improvement for identified target populations.
2. Identify new models of workforce development and deployment and related training and education that support new models either directly or through new infrastructure activities.
3. Support innovators who can rapidly deploy care improvement models (within six months of award) through new ventures or expansion of existing efforts to new populations of patients, in conjunction (where possible) with other public and private sector partners.

The anticipated award date is March 30, so stay tuned! For more information about the CMS Innovation Challenge, click here.

Care Innovations Summit 2012

The Center for Medicare & Medicaid Innovation is co-hosting the first ever Care Innovations Summit, an HCI-DC event, on January 26, 2012, in Washington, DC in collaboration with the Office of the National Coordinator at HHS, The West Wireless Health Institute, and Health Affairs to facilitate dialogue and drive action towards the three-part aim.

When: January 2012
Where: Washington, DC
Twitter Hashtag: #cisummit

The Co-hosts

• Center for Medicare & Medicaid Innovation
• Office of the National Coordinator for Health IT
• The West Wireless Health Institute
• Health Affairs

Learn more about Care Innovations Summit 2012 here.

The AMA wants this YouTube video to go viral. Will you help?

The American Medical Association (AMA) wants to communicate to Congress that now is the time to repeal Medicare's flawed SGR (Sustainable Growth Rate) formula. They're hoping to get this YouTube video to go viral. Will you help?



This video is sponsored by the following organizations:

American Medical Association
American Academy of Dermatology Association
American Academy of Family Physicians
American Academy of Ophthalmology
American College of Cardiology
American College of Physicians
American College of Surgeons
American Osteopathic Association
American Psychiatric Association
American Society of Cataract and Refractive Surgery
Medical Group Management Association

Attestation for the Medicare EHR Incentive Program is now open

Registration for the Medicare and Medicaid EHR Incentive Programs is now open. You can register here: https://ehrincentives.cms.gov/hitech/login.action

• Medicare Eligible Professionals (EPs) are mainly physicians.
• Medicaid Eligible Professionals (EPs) include a broader audience including nurse practitioners, Physicians Assistants who practice in a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) that is led by a Physician Assistant, and others.

The Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs will provide incentive payments to eligible professionals and eligible hospitals as they demonstrate adoption, implementation, upgrading, or meaningful use of certified EHR technology. These incentive programs are designed to support providers in this period of Health IT transition and instill the use of EHRs in meaningful ways to help our nation to improve the quality, safety, and efficiency of patient health care.

To read about the EHR Incentive Program, click here.

Medicare Payments for Graduate Medical Education: What Every Medical Student, Resident and Advisor Needs to Know

If you're currently in residency training and you're thinking about switching to a different specialty, make sure you read this AAMC publication titled, "Medicare Payments for Graduate Medical Education: What Every Medical Student, Resident and Advisor Needs to Know."

Medicare funds a significant portion of post-graduate training and there is a limit on how much funding a single resident may receive during his or her residency training. If you want to switch from one specialty to another, consider the funding issue that you may face and speak with your program director after you read the AAMC report.

Are you prepared for the 2011 Medicare Participation Decision?

Physicians will have until Dec. 31, 2010, to modify their status with the Medicare program, and will want to carefully weigh their options. The American Medical Association (AMA) is once again hosting a live webinar on Medicare participation options for 2011. Join AMA President Cecil B. Wilson in this informative webinar as he walks physicians through their Medicare participation options to guide them through their decision in advance of the Dec. 31 deadline. In wake of looming Medicare payment cuts, physicians face a tough decision when it comes to participation in the Medicare program in 2011.

The webinar will cover:

* Advantages and disadvantages of each participation option: participation in Medicare, nonparticipation in Medicare, or opting out of Medicare and privately contracting with patients.
* Examples of how payments are calculated under each option
* New regulations on 2011 Medicare physician payment policy changes
* AMA resources that help physicians gauge which Medicare option is right for their practice

Date: Thu, Dec 2, 2010
Time: 06:30 PM EST
Duration: 1 hour

Click here to learn more.

Blue Button for Downloading Health Information

New Markle Survey Finds U.S. Public and Doctors Alike Support ‘Blue Button’ for Downloading Health Information

· Roughly 2 in 3 of the public and doctors agree that people should be able to download their personal health information.
· Government leads the way: Both Medicare and the VA for the first time ever offer a blue button for beneficiaries and veterans.
· Delivering electronic copies to patients is important, majority of public says, for billions in health IT incentives to doctors and hospitals to be well-spent.
· More than 80 percent of the public and doctors call privacy safeguards an important requirement for health IT incentives program.

SAN FRANCISCO, CA—Both the U.S. public and doctors overwhelmingly agree that people should be able to go online to download copies of their medical information, according to a new survey released today by the Markle Foundation.

Snapshots of the Markle Survey on Health in a Networked Life 2010—the first of its kind to compare public and doctor priorities for health information technology—will be previewed at the Health 2.0 conference this week in San Francisco.

The Official Web Site for the Medicare and Medicaid EHR Incentive Programs

In case you didn't know about it, the government has created an "Official Web Site for the Medicare and Medicaid EHR Incentive Programs."

It's on the CMS website here:
http://www.cms.gov/EHRIncentivePrograms/

Here's what you'll find if you visit that site:

•  Overview
•  Spotlight and Upcoming Events
•  Getting Started
•  Eligibility
•  Certification
•  Meaningful Use
•  Registration
•  Medicare Eligible Professional
•  Medicaid Eligible Professional
•  Hospitals
•  Medicare Advantage
•  Information for States
•  Frequently Asked Questions and Educational Materials

The nation’s healthcare system is undergoing a transformation in an effort to improve quality, safety and efficiency of care, from the upgrade to ICD-10 to information exchanges of EHR technology.   To help facilitate this vision, the Health Information Technology for Economic and Clinical Health Act, or the "HITECH Act" established programs under Medicare and Medicaid to provide incentive payments for the "meaningful use" of certified EHR technology.  The Medicare and Medicaid EHR incentive programs will provide incentive payments to eligible professionals and eligible hospitals as they  adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology.  The programs begin in 2011. These incentive programs are designed to support providers in this period of Health IT transition and instill the use of EHRs in meaningful ways to help our nation to improve the quality, safety and efficiency of patient health care.

NOTE: This is a new program, and it is separate from other active CMS incentive programs, such as Physicians Quality Reporting Initiative (PQRI), Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) and e-Prescribing.

To learn more, visit: http://www.cms.gov/EHRIncentivePrograms/

Ingenix to Acquire Executive Health Resources

Eden Prairie, MN and Newtown Square, PA, August 4, 2010 – Ingenix, a leading health information technology and services company, today announced it is acquiring Executive Health Resources, a leading provider of medical necessity compliance and physician medical management solutions for hospitals.  The transaction is subject to regulatory approval and other customary closing conditions and is expected to close before the end of 2010.

Combined, Executive Health Resources and Ingenix will have a greater ability to help hospitals manage medical necessity compliance requirements as hospitals and health systems serve an increasing volume of patients with government-sponsored health benefit plans.  Executive Health Resources’ Physician Advisor teams provide hospitals and health systems with the dedicated, technology-supported services needed to assist hospitals with managing compliance with Centers for Medicare & Medicaid Services (CMS)- and state-directed medical necessity rules and regulations. Ingenix offers consulting, information systems and services that help hospitals maintain the highest quality of care and improve operational efficiency.

Under federal and state law, hospitals and health systems must perform compliance reviews for medical services provided to patients covered by Medicare and Medicaid programs to ensure that care is medically necessary and delivered in the proper care setting.  Congress expanded federal auditing oversight in 2006 to all 50 U.S. states in an effort to reduce federal payment discrepancies with hospitals.  Executive Health Resources provides evidence-based clinical intelligence and Physician Advisors highly-trained in CMS rules and regulations to support hospitals in complying with federal and state provisions related to medical necessity.

Medicare payment changes under reform bill

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (H.R. 3590) into law. Some physicians opposed it while others favored it. How will this new reform bill affect Medicare payments? Well, the AMA has developed a handy resource that outlines the Medicare payment changes:

Although Congress will address the flawed sustainable growth rate formula in separate legislation later this year, H.R. 3590 includes a number of payment improvements for physicians that, combined, will result in immediate and significant Medicare payment increases for many physicians.

• 10 percent incentive payments for primary care physicians. All physicians in family medicine, general internal medicine, geriatrics and pediatrics whose Medicare charges for office, nursing facility and home visits comprise at least 60 percent of their total Medicare charges will be eligible for a 10 percent bonus payment for these services from 2011–16.

• 10 percent incentive payments for general surgeons performing major surgery in health professional shortage areas. All general surgeons who perform major procedures (with a 10- or 90-day global service period) in a health professional shortage area will be eligible for a 10 percent bonus payment for these services from 2011–16.

• 5 percent incentive payment for mental health services. For 2010, Medicare will increase payment for psychotherapy services by 5 percent.

Dr. Sanjay Gupta here at #HIMSS10 discussing Medicare fraud @SanjayGuptaCNN

For some of you, HIMSS10 may be over. The exhibit hall closed yesterday, but the educational sessions are still continuing. This morning, I had the chance to see Dr. Sanjay Gupta from CNN interview Harry Markopolos, CPA. The discussion revolved around Medicare fraud which is a huge problem in this country.

Here were some key points from this keynote:

• Medicare fraud story: $100 million were being billed by criminals who were using the names of deceased physicians.
• Roughly $80 billion - fraud? Maybe $40 billion? Probably $60 billion each year. 
• Discussion revolved the Bernie Madoff Ponzi scheme.
• Do we need "undercover" patients to investigate whether doctors are breaking Medicare rules? (your next patient could be wearing a wire)
• Only $20 million is spent on fraud investigation. Is this enough?
• If women are being billed for male diseases, this could signal fraud (women won't be diagnosed or treated with prostate cancer)
• Examples of Medicare fraud: upcoding, billing for procedures that were never done, off-label marketing, kickbacks, etc.
• Where is the Medicare fraud occurring? Some doctors may feel a sense of entitlement and they may rationalize their behavior. 
• The EHR may be a double-edged sword. Medicare fraud may be easier to detect, but you may lose some evidence. 
• Don't title your accounts "slush funds" or "kickback accounts" because that may indicate that fraud may be occurring.
• Some doctors are billing for 80 hours of day. (not a typo - 80 hours each day)
• Whistle blowers receive a financial incentive based on the final settlement.
• Corporate integrity agreements result in additional IT work and reports.
• Will Medicare go bankrupt by 2017 or 2019?
• Some hospice providers may be caring for dead patients.  
• The worst nightmare for an IT professional is a Medicare fraud investigation. 
• How do we protect Medicare beneficiaries?  Check their charts and their medical bills.
• Some physicians are being trained by "senior staff" to upcode. Do you know how to bill accurately?

Special thanks to HP for sponsoring me to blog about HIMSS10.

Learn How to Get Paid for Meaningful Use (EHR)

HIMSS is having a webinar today from a series of webinars titled, "Learn How to Get Paid for Meaningful Use."

Today's webinar is: "The Economics of ARRA: Understanding the Payments for both Medicare and Medicaid"

You won’t want to miss the latest in the HIMSS Webinar Series on Meaningful Use and Certification, where you’ll gain a comprehensive understanding of how ARRA has impacted Medicare and Medicaid payments including, participation determination, timing, payment amounts, and insights into the required audits on various health IT incentive programs. 

The speaker is:
Patricia Wise, RN, MSN, MA, FHIMSS, Col. USA (retired), Vice President, Healthcare Information Systems, HIMSS.




All sessions are complimentary for HIMSS Members (member ID required) and $79 for non-members. To register for any of the webinars, click here.

@sanjayguptacnn Dr. Sanjay Gupta will be speaking at HIMSS10

Dr. Sanjay Gupta is the Chief Medical Correspondent on CNN. I admire the way that he's been leveraging social media like blogs and Twitter to communicate with patients and health care professionals. If you'll be attending HIMSS10 (Healthcare Information and Management Systems Society), you'll have the opportunity to see him speak on March 4 during the special keynote session. Dr. Gupta will be interviewing Harry Markopolos about Medicare fraud, so you won't want to miss that.

Are you planning on attending HIMSS? I'm really looking forward to this conference. It's such a great place to expand your professional network and to learn about the exciting things that are happening in the world of health information technology (health IT).

America's Best Nursing Homes

The February edition of US News has a section titled, "America's Best Nursing Homes" and it lists some of the top nursing homes in various states. If you're thinking about long-term care for yourself or for a loved one, then you may want to look at this list.

In my region, some of the top nursing homes (according to US News) include:

• Crosslands in Kennett Square, PA
• Calvary Fellowship Homes in Lancaster, PA
• Holy Name Friary in Ringwood, NJ
  
• Cokesbury Village in Hockessin, DE
• Our Lady of Hope Residence in Latham, NY

There are 173 nursing homes listed and some scored a total of 15 stars while others scored a total of 14 stars in 3 different categories. All the homes listed scored 5 stars overall, the highest rating by the Centers for Medicare & Medicaid Services (CMS).

You can also view the Medicare.gov - Nursing Home Compare website to do some research about different nursing homes in your area (www.medicare.gov/nhcompare).

Free e-Prescribing with Practice Fusion (free EHR)

You may have already heard this, but Practice Fusion (free EHR) now offers a free e-Prescribing solution. Have your DEA and NPI numbers ready.

Practice Fusion Launches Free e-Prescribing

e-Prescribing system integrated into free, web-based EHR. Available to all doctors. Helps avoid medication errors, qualifies for Medicare incentives, saves time and serves patients.

Practice Fusion's free e-prescribing system includes:

    * Connection to over 50,000 pharmacies
    * Continuously updated medication library
    * Same-day enrollment for most providers
    * Flexibility to use e-prescribing as a stand-alone feature or as part of the comprehensive free EHR system
    * Easy pharmacy look-up with filters for proximity to the practice or patient address
    * Refill requests delivered back to the practice directly from the pharmacy
    * Instant prescription details delivered to the patient Personal Health Record online
    * Unlimited free set-up assistance, migration help, training and support
    * Qualification for the Medicare e-prescribe bonus

You can read the full press release here.